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22 Cards in this Set
- Front
- Back
Calcium Channel Blockers
- Drugs in class |
1. Verapamil
2. Diltiazem 3. Dihydropyridines (a) amlodipine (b) nifedipine (c) felodipine (d) lecarnidipine (e) nimodipine |
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Calcium channel blockers
- MOA |
Block inward current of calcium into cells. This reduces vascular smooth muscle contraction, and reduce heart rate and conduction
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CCBs
- Indications - Indication for nimodipine - Indication for verapamil |
1. Hypertension
2. Angina & vasospasm (e.g. post CABGs) Nimodipine may prevent cerebral ischaemic damage from vasospasm after subarachnoid haemorrhage Verapamil: rate control of AF, prevent and treat SVT Nifedipine: threatened preterm labour (tocolytic) |
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1. Relative duration of action of dihydropyridines & onset of action
2. Special instructions for verapamil? |
1. Nifedipine and felodipine have shorter half-lifes. CR preparations are available so that they are only dosed daily.
Felodipine and amlodipine have a faster onset of action (even though nifedipine is used as a tocolytic) 2. (a) Care with alcohol initially. May prolong it's effect. (b) Label 13 (c) Label B: with food: applies to the SR tablets but not to the IR tabs or Veracaps (d) Veracaps can be sprinkled over APPLE SAUCE prn (e) the SR tabs can be halved (240-->120) if individuals are sensitive. |
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Use of CCBs in HTN
1. CF other AHs in the elderly? 2. In HF? |
1. In the elderly, felodipine and long acting nifedipine are as effective as diuretics and BBs
2. Amlodipine and felodipine have been shown not to increase morbidity in HF |
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CCBs in angina
- how do they compare to other treatments? |
- as effective as BBs but only CR verapamil has been shown to decrease cardiovascular events
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CCBs
- CIs - BF/Preg |
CI: cardiogenic shock; Verapamil and diltiazem also CI in severe bradycardia(v), AV block, severe hypotension
- Preg Cat C: maternal hypotension may cause fetal hypoxia BF: Nifedipine "seems safe", rest have ltd or no data |
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CCBs:
- Adverse effects - management of the obvious one |
Common
- HEADACHE, FLUSHING, FATIGUE, PERIPHERAL OEDEMA (for V+D AND dihydropyridines - gingival hyperplasia (rare for v,d) - bradycardia (v,d only) - constipation (v - others infrequent) Do not treat peripheral oedema with diuretics, may cause volume depletion |
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Amlodipine
- brands, dose forms, doses |
Amlo, Norvasc, Perivasc
5mg.30, 10mg.30 Caduet (PBS-R) 5mg with 10/20/40/80 10mg with 10/20/40/80 Dose: 5mg-10mg daily (start at 2.5 if old or HI) |
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Felodipine
- brands, dose forms, doses - Special instructions |
Felodur ER, Plendil ER, Felodil XR
2.5mg, 5mg, 10mg.30 enteric coated tablets 2.5-20mg d (start on 2.5 if old or HI) - Swallow whole(A), L18, L5, L9, L12 (on initiation) **NB: they make a 2.5mg because you can't halve it!!! |
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Lecarnidipine
- brands, dose forms, doses - When can you increase dose (remember time to onset on action) - Extra contraindications |
Zanidip, 10mg/20mg.30 tabs
10-20mg d (increase after 2 weeks) CI in RI <12ml/min, severe hepatic impairment & manufacturer CI with cyclosporin |
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Nifedipine
- brands, dose form, doses - Dose equivalence |
Adalat, Adefin, Nyefax(20mg)
10mg.60, 20mg.60 TABS 20mg.30, 30mg.30, 60mg.30 CR tabs: Adalat Oros, Addos XR, Adefin XL 10-40mg bd 20-90mg d (CR), max 90mg angina, max 120mg HTN To change, calc daily dose and choose the closest CR tab d. |
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Nimodipine
- brand, dose form, doses - indications - pbs listin |
Nimotop
30mg.100 tab, 0.2mg/ml injection For prevention and treatment of ischaemic deficits following subarachnoid haemorrhage ONLY Not on PBS |
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Verapamil
- brand, dose forms, dose |
40mg.100, 80mg.100, 120mg.100, 160mg.60 (Isoptin, Anpec)
180mg.30, 240.30 CR tab (Isoptin SR, Cordilox SR, Anpec SR) 160mg.30, 240mg.30 CR CAPS (Veracaps SR) 2.5mg/mL.2mL inj (Isoptin) 240mg/4mg.28 CR tab for HTN(Takra,with trandolapril) IR tab: start of 80mg bd-tds, then maintain on 160mg bd-tds CR tab: 120-240 HTN (160-240 for angina) d. Max 240mg bd. Arrythmia: doses as above (120-480mg d) |
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Diltiazem
- brands - dose forms doses |
60mg.90 tab (Vasocardol, Cardizem, Coras, Dilzem, Diltahexal)
180mg.30, 240mg.30, 360mg.30 SR CAP (Cardizem CD, Vasocardol CD, Dilzem CD, Diltahexal CD) Doses HTN: 180-360mg d (SR only) Angina: 30mg tds-qid (max 240mg d) Angina CR: 180-360mg d |
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How should CCB induced peripheral oedema be treated?
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It shouldn't. Treatment may put patients at risk of volume depletion.
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CCB DIs
(a) applying to all drugs in class (b) applying to verapamil and diltiazem (c) just verapamil |
(a) decreasing BP
(b) - inhibitors of CYP3A4 (avoid with atorvastatin, simvastatin, buspirone, Calcineurin inhibitors, CBZ, phenytoin, imipramine=heartblock, - metabolised by CYP3A4 (avoid cimetidine, rifampicin - slow cardiac conduction and causes bradycardia (c) - antiarhythmics: increased risk of bradycardia, HF, arrhythmia; AVOID - avoid Beta-blockers, INCLUDING EYE DROPS, unless under specialist supervision |
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CCBs
Which labels go on which CCBs? |
All have label 18, except: amlodipine, diltiazem (verapamil does have it!)
All also have: label 9, 12+ (if new but verapamil has a permanent label 12) Some have label A (swallow whole): e.g. SR felodipine, nifedipine, diltiazem, verapamil N.B. veracaps can be opened and sprinkled prn Label 5: felodipine (affected by both inhibitors and inducers of CYP3A4) Verapamil also has: 13, and B (which formulations?) & may increase and prolong the effects of alcohol in some people - limit EtOH until you know how you are effectes |
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CCBs - DIs
(e) nifedipine |
- potent CYP3A4 inhibitors increase conc
- increases effect of MgSO4 (eclampsia / tocolytic) - increases conc of digoxin |
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CCBs - DIs
(f) lecarnidipine |
- CYP3A4 inhibitors
- metoprolol DECREASES lecarnidipine concentration and MAY reduce activity |
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CCBs - DIs
(g)felodipine |
- CYP3A4 inhibitors and inducers....nb.. label 5
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CCBs - DIs
amlodipine |
ALMOST NONE
- cyclosporin conc may be increased |